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Hill CM, Chi DL, Mancl LA, Jones-Smith JC, Chan N, Saelens BE, McKinney CM. Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state. PLoS One 2023; 18:e0290287. [PMID: 37699013 PMCID: PMC10497152 DOI: 10.1371/journal.pone.0290287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children. MATERIALS AND METHODS Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects. RESULTS Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33). CONCLUSIONS Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.
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Affiliation(s)
- Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Jessica C. Jones-Smith
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Nadine Chan
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Public Health-Seattle & King County, Assessment, Policy, Development and Evaluation Division, Seattle, WA, United States of America
| | - Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Christy M. McKinney
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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Falbe J, Marinello S, Wolf EC, Solar SE, Schermbeck RM, Pipito AA, Powell LM. Food and Beverage Environments at Store Checkouts in California: Mostly Unhealthy Products. Curr Dev Nutr 2023; 7:100075. [PMID: 37250387 PMCID: PMC10213198 DOI: 10.1016/j.cdnut.2023.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background As the only place in a store where customers must pass through, checkouts may be especially influential over purchases. Research is needed to understand the healthfulness of checkout environments. Objectives The objective of this study was to classify checkout product facings in California food stores. Methods In a cross-sectional study, 102 stores, including chains (dollar stores, drugstores, specialty food stores, supermarkets, and mass merchandisers) and independent supermarkets and grocery stores were sampled from 4 northern California cities. Observational assessments of each checkout product facing were conducted in February 2021 using the Store CheckOUt Tool. Facings were classified by category and healthfulness, defined by meeting Berkeley's Healthy Checkout Ordinance's healthy checkout standards: unsweetened beverages and specific foods containing ≤5 g added sugar and ≤200 mg sodium per serving. Log binomial regressions compared healthfulness by store and checkout characteristics. Results Of 26,758 food and beverage checkout facings, the most common categories were candy (31%), gum (18%), sugar-sweetened beverages (SSBs; 11%), salty snacks (9%), mints (7%), and sweets (6%). Water represented only 3% and fruits and vegetables 1% of these facings. Only 30% of food and beverage facings met Berkeley's healthy checkout standards, with 70% not meeting the standards. The percentage of food and beverage facings not meeting the standards was even higher (89%) among snack-sized packages (≤2 servings/package). Compared with chain supermarkets, mass merchandisers, and specialty food stores (34%-36%), dollar and independent grocery stores had a lower percentage of food and beverage facings that met the healthy checkout standards (18%-20%; P < 0.05). Compared with lane and register areas (35%), endcaps and snaking sections within checkouts had fewer food and beverage facings that met the standards (21%-23%; P < 0.001). Conclusions Most foods and beverages at checkout consisted of candy, SSBs, salty snacks, and sweets and failed to meet the healthy checkout standards.Curr Dev Nutr 2023;xx:xx.
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Affiliation(s)
- Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Samantha Marinello
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Ethan C. Wolf
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
- Public Health Nutrition Program, Community Health Sciences, UC Berkeley School of Public Health, Berkeley, CA, United States
| | - Sarah E. Solar
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Andrea A. Pipito
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
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Winkler MR, Lenk K, Erickson DJ, Laska MN. Retailer Marketing Strategies and Customer Purchasing of Sweetened Beverages in Convenience Stores. J Acad Nutr Diet 2022; 122:2050-2059. [PMID: 35240342 PMCID: PMC9420172 DOI: 10.1016/j.jand.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Marketing strategies for sweetened beverages (SBs) are pervasive across food retail. Yet few studies have examined how these strategies associate with planned and unplanned SB purchasing. OBJECTIVE This study aimed to examine whether customers with greater exposure to SB retail marketing (eg, advertisements and product placement) were more likely to purchase an SB and whether this varied by customer characteristics. DESIGN This was an observational, cross-sectional study using objective customer purchasing and store assessment data from convenience and other small food stores. PARTICIPANTS/SETTING Participants were 1,604 food and beverage customers at 144 randomly sampled convenience and other small food stores in Minneapolis-St Paul, MN. EXPOSURE Marketing strategies, including SB advertisements, placement, and shelf space were included. MAIN OUTCOME MEASURES We determined the probability of customers purchasing ≥4 fluid ounces of a ready-to-drink sugar and/or artificially sweetened beverage. STATISTICAL ANALYSES PERFORMED Associations between marketing strategies and purchasing were estimated using mixed regression models, controlling for customer characteristics and accounting for customers nested within stores. RESULTS Fifty-six percent of customers purchased an SB; 14% also specified that it was an unplanned purchase. Customers were more likely to purchase an SB when exterior advertisements (P < .001) and advertisements hanging from the ceiling (P < .001) that promoted SBs were present. Customers with moderate and high cumulative exposure to SB marketing were significantly more likely to purchase SBs (51.2% and 54.9%, respectively) than those with lower exposure (34%); this effect was particularly salient for men. There were no significant associations between retail marketing strategies and unplanned purchases. CONCLUSIONS Findings demonstrate that feasible and sustainable approaches are required from policy makers, retailers, and public health professionals to shift store environments away from cues that promote unhealthy beverage selections. Given that numerous retail actors are invested in the availability, promotion, and sales of SBs, changing the predominance of SB marketing in convenience stores will likely be challenging and require cross-sector collaboration.
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Affiliation(s)
- Megan R Winkler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Kathleen Lenk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Darin J Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Melissa N Laska
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Winkler MR, Lenk K, Erickson D, Laska MN. Secular trends and customer characteristics of sweetened beverage and water purchasing at US convenience and other small food stores, 2014-2017. Int J Behav Nutr Phys Act 2022; 19:37. [PMID: 35361242 PMCID: PMC8973807 DOI: 10.1186/s12966-022-01268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Cardiovascular health is linked to sugar- and artificially-sweetened beverages (SSBs and ASBs). Prior studies document declines in SSB purchases. However, it is unclear if similar trends exist at convenience and other small food outlets, which often serve lower-income communities and where objective point-of-sales data are difficult to obtain. We examined trends (2014–2017) in observed SSB, ASB, and water purchases at convenience and other small stores as well as differences in purchasing by customer characteristics. Methods We used observational purchase data collected annually (2014–2017) from 3010 adult customers at 147 randomly-sampled stores in Minneapolis/St. Paul, USA. SSB sub-types included any ready-to-drink sweetened soda, fruit, sport, energy, tea, or other drink, and ASBs included artificially-sweetened versions. Unsweetened water included ready-to-drink water. Mixed regression models examined trends over time and associations with customer characteristics, accounting for customers nested within stores and stores repeatedly measured over time. Results Nearly 50% of purchases included an SSB. Approximately 10% included an ASB. There was no evidence of change over time in SSB or ASB purchasing. Customer purchasing of unsweetened water significantly increased over time (5.7 to 8.4%; P for trend = 0.05). SSB purchasing was highest among men, young adults, customers with lower education/ income, and customers that shopped frequently. ASB purchasing was highest among women, those 40–59 years, non-Hispanic White, Hispanic, and customers with higher education/ income. Conclusions Despite research suggesting previous declines in SSB consumption and purchasing in the US, we identified a persistent, high trend of SSB purchasing overtime at convenience and other small food stores. Consumption of SSBs and water are growing targets for public policy and health campaigns. Results demonstrate additional work is needed curb sweetened beverage purchasing and promote water purchasing at convenience and other small food stores, which are often prevalent in low-income and marginalized communities.
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Affiliation(s)
- Megan R Winkler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA. .,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Kathleen Lenk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Darin Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Lynch M, Mah CL. “Fronts for Drugs, Money Laundering, and Other Stuff”: Convenience Stores in the Retail Food Environment. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.2002747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Lynch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C. L. Mah
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Health Administration, Dalhousie University, Halifax, Canada
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Socio-economic and racial/ethnic disparities in the nutritional quality of packaged food purchases in the USA, 2008-2018. Public Health Nutr 2021; 24:5730-5742. [PMID: 33500012 DOI: 10.1017/s1368980021000367] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether disparities exist in the nutritional quality of packaged foods and beverage purchases by household income, education and race/ethnicity and if they changed over time. DESIGN We used Nielsen Homescan, a nationally representative household panel, from 2008 to 2018 (n = 672 821 household-year observations). Multivariate, multilevel regressions were used to model the association between sociodemographic groups and a set of nutritional outcomes of public health interest, including nutrients of concern (sugar, saturated fat and Na) and calories from specific food groups (fruits, non-starchy vegetables, processed meats, sugar-sweetened beverages and junk foods). SETTING Household panel survey. PARTICIPANTS Approximately 60 000 households each year from the USA. RESULTS Disparities were found by income and education for most outcomes and widened for purchases of fruits, vegetables and the percentage of calories from sugar between 2008 and 2018. The magnitude of disparities was largest by education. Disparities between Black and White households include the consumption of processed meats and the percentage of calories from sugar, while no disparities were found between White and Hispanic households. Disparities have been largely persistent, as any significant changes over time have been substantively small. CONCLUSIONS Policies to improve the healthfulness of packaged foods must be expanded beyond SSB taxes, and future research should focus on what mediates the relationship between education and diet so as not to exacerbate disparities.
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Falbe J, Lee MM, Kaplan S, Rojas NA, Ortega Hinojosa AM, Madsen KA. Higher Sugar-Sweetened Beverage Retail Prices After Excise Taxes in Oakland and San Francisco. Am J Public Health 2020; 110:1017-1023. [PMID: 32437271 PMCID: PMC7287565 DOI: 10.2105/ajph.2020.305602] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To examine how much sugar-sweetened beverage (SSB) excise taxes increased SSB retail prices in Oakland and San Francisco, California.Methods. We collected pretax (April-May 2017) and posttax (April-May 2018) retail prices of SSBs and non-SSBs from 155 stores in Oakland, San Francisco, and comparison cities. We analyzed data using difference-in-differences high-dimensional fixed-effects regressions, weighted by regional beverage sales.Results. Across all beverage sizes, the weighted average price of SSBs increased by 0.92 cents per ounce (95% confidence interval [CI] = 0.28, 1.56) in Oakland and 1.00 cents per ounce (95% CI = 0.35, 1.65) in San Francisco, compared with prices in untaxed cities. The tax did not significantly alter prices of water, 100% juice, or milk of any size examined. Diet soda only, among non-SSBs, exhibited a higher price increase for some sizes in taxed cities.Conclusions. Within 4 to 10 months of implementation, Oakland's and San Francisco's SSB excise taxes significantly increased SSB retail prices by approximately the amount of the taxes, a key mechanism for reducing consumption.
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Affiliation(s)
- Jennifer Falbe
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Matthew M Lee
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Scott Kaplan
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Nadia A Rojas
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Alberto M Ortega Hinojosa
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Kristine A Madsen
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
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BeLue R, NDao F, McClure S, Alexander S, Walker R. The Role of Social Issues on Food Procurement among Corner Store Owners and Shoppers. Ecol Food Nutr 2019; 59:35-46. [PMID: 31475574 DOI: 10.1080/03670244.2019.1659789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We assessed corner store shopper and owner perceptions, barriers, and enablers related to food procurement in a sample of neighborhood corner stores where over 50% of families are SNAP eligible. DESIGN We conducted semi-structured interviews to identify inventory stocking, shopping and marketing approaches, and perspectives on healthy eating. PARTICIPANTS Five corner store owners and 20 corner store shoppers. RESULTS Corner store owners: 1) did not feel as though they belonged to the community where their corner store was located; 2) had difficulty in becoming authorized WIC retailers because of the perceived complexity of the process, and 3) stated tobacco products and hot food items are their best-selling items; fruits and vegetables were perceived as unmarketable. Corner store shoppers preferred shopping at local corner stores because: 1) lack of transportation made corner stores easier to access than full-service grocery stores; 2) hot foods are readily available and inexpensive; 3) some home kitchens lacked an oven or stovetop for meal preparation; 4) they need to shop daily for children or other family members. CONCLUSIONS Social issues such as housing quality, corner store owner sense of community, and acculturation should be addressed when considering food environment in limited resource communities.
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Affiliation(s)
- Rhonda BeLue
- Department of Health Management and Policy, Saint Louis University College of Public Health and Social Justice, Saint Louis, MO, USA
| | - Fatou NDao
- Penn State University College of Medicine, Hershey, PA, USA
| | - Stephanie McClure
- Department of Health Management and Policy, Saint Louis University College of Public Health and Social Justice, Saint Louis, MO, USA
| | - Suzanne Alexander
- Department of Health Management and Policy, Saint Louis University College of Public Health and Social Justice, Saint Louis, MO, USA
| | - Renee Walker
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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